Provider Demographics
NPI:1467797472
Name:WOOLEY, SELENA MARIE (LAC, AP)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:MARIE
Last Name:WOOLEY
Suffix:
Gender:F
Credentials:LAC, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 PEORIA RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-7620
Mailing Address - Country:US
Mailing Address - Phone:904-868-9615
Mailing Address - Fax:
Practice Address - Street 1:3207 PEORIA RD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-7620
Practice Address - Country:US
Practice Address - Phone:904-868-9615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-02
Last Update Date:2012-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2987171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist